Survival and associated factors of mortality of preterm neonates admitted to Felege Hiwot specialized hospital, Bahir Dar, Ethiopia

Abstract

Background: The complication of prematurity is the second commonest cause of under-five mortality in Ethiopia. Amhara region has the highest neonatal mortality rate in the country. There was no previous study and this study aimed to assess the survival of preterm neonates and its associated factors of preterm neonatal mortality admitted to Felege Hiwot Specialized Hospital, Bahir Dar, Ethiopia, to take necessary action to maximize survival of preterm babies in developing countries.

Methods: A retrospective cross-sectional study was conducted among 686 preterm neonates admitted in Felege Hiwot Specialized Hospital from 1 August 2017 to 30 July 2018. Kaplan-Meier survival curve was used to show the survival rate of preterm neonates and the multivariate Cox proportional hazards model was used to identify covariates of survival of preterm neonates. Those variables having a p-value less than 0.05 were statistically significant for the survival of preterm neonates.

Result: Out of 686 preterm neonates admitted from 1 August 2017 to 30 July 2018, 49.1% neonates were improved and discharged and 36.1% died. The survival rate was 0%, 19.4%, 46.7% and 75% for gestational age <28 weeks, 28-31 + 6 weeks, 32-33 + 6 weeks and 34-36 + 6 weeks, respectively. In the multivariate Cox regression model, respiratory distress syndrome, necrotizing enterocolitis, asphyxia, hospital-acquired infection, birth weight, gestational age and place of delivery were significantly associated with time to death of preterm neonates at 95% confidence level (p < 0.05).

Conclusion: The mortality rate (36.1%) of preterm neonates is unacceptably high in Felege Hiwot hospital compared to other similar hospitals in Ethiopia. More than 50% of preterm neonatal deaths can be prevented with available resources. Neonatal units with adequate and committed manpower, using a strict aseptic technique, proper follow-up, early detection and timely management of complications, are recommended to improve the survival of preterm neonates.

Keywords: Analysis; neonates; preterm; survival.

Figure 1.

Flow diagram of the overall recruitment of preterm neonates in Felege Hiwot hospital, Bahir Dar, Ethiopia, from 1 August 2017 to 30 July 2018.

Figure 2.

Kaplan–Meier curve comparing survival of preterm with neonates RDS versus without RDS.

Figure 3.

Kaplan–Meier curve of survival of preterm neonates based on gestational age category.

Figure 4.

KM curve comparing survival of preterm neonates based on admission temperature.

Figure 5.

KM curve comparing survival of preterm neonates based on place of birth.

Figure 6.

Summary of KM survival estimate of time to death of neonates admitted at FHSH, Bahir Dar, Ethiopia, from 1 August 2017 to 30 July 2018 (n = 686). The graph shows the proportion of neonates who died during the hospital stay. During the first 10 days, the graph went down sharply which shows a higher proportion of death of neonates. More than 92% of death occurs in the first 10 days of admission.